Wang Shangqian, Qin Chao, Peng Zhihang, Cao Qiang, Li Pu, Shao Pengfei, Ju Xiaobing, Meng Xiaoxin, Lu Qiang, Li Jie, Wang Meilin, Zhang Zhengdong, Gu Min, Zhang Wei, Yin Changjun
Department of Urology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
Department of Epidemiology and Biostatistics.
Chin Med J (Engl). 2014;127(13):2497-503.
Over the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).
The US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.
Patients who underwent RFA were significantly older (P < 0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P < 0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P < 0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P < 0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P < 0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P < 0.001).
The current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.
在过去二十年中，肾肿块的临床表现有所演变，小肾肿块（SRMs）发病率上升以及随之而来的微创治疗手段增加，导致肾癌治疗模式发生了显著变化。本研究旨在对关于部分肾切除术（PN）和射频消融术（RFA）围手术期并发症及肿瘤学结局的观察性研究进行比例荟萃分析。
在2013年8月1日前全面检索了美国国立医学图书馆的生命科学数据库（Medline）和科学网。纳入接受PN或RFA治疗的临床1期SRMs患者，并分析了总共9565例患者的围手术期并发症及肿瘤学结局。
接受RFA治疗的患者年龄显著更大（P < 0.001）。在T1期肿瘤的亚组分析中，PN的主要并发症发生率高于RFA（腹腔镜下部分肾切除术（LPN）/机器人辅助部分肾切除术（RPN）：7.2%，开放性部分肾切除术（OPN）：7.9%，RFA：3.1%，P均< 0.001）。RFA后轻微并发症发生更频繁（RFA：13.8%，LPN/RPN：7.5%，OPN：9.5%，P均< 0.001）。通过多变量分析，与LPN和OPN相比，RFA发生轻微并发症的相对风险分别高1.7倍和1.5倍（P均< 0.01）。接受RFA治疗的患者局部进展率高于接受PN治疗的患者（RFA：4.6%，LPN/RPN：1.2%，OPN：1.9%，P均< 0.001）。通过多变量分析，RFA相对于LPN/RPN和OPN的局部肿瘤进展分别高4.5倍和3.1倍（P均< 0.001）。
目前的数据表明，PN和RFA都是治疗SRMs的可行策略。与PN相比，RFA显示出局部肿瘤进展风险更高，但主要并发症发生率更低，这对于身体状况较差的患者可能更好。PN无疑是SRMs的金标准治疗方法，LPN已被经验丰富的泌尿外科医生广泛接受为保肾手术的首选。RFA可能是部分合并症严重患者的最佳选择。
